Texas’ power grid struggled to get homes and business back online after Hurricane Beryl made landfall as a Category 1 storm last week, leaving some assisted living communities and nursing homes grappling to keep residents cool during a heat wave.

Ella Springs Senior Living, an assisted living and memory care community in Houston, lost power for four days. Staff members worked not only to keep residents cool, but to run constant checks on residents since the power outage also meant that its emergency alert system was not working and that door locks keeping memory care residents from wandering deactivated, according to the Texas Tribune. 

According to the media outlet, Ella Springs was among 30 assisted living communities and 14 nursing homes in Harris County alone that were without power for days. Most had their power restored by Friday morning, but the experience had operators and lawmakers questioning processes and procedures.

Texas Health Care Association President and CEO Travis Clardy told McKnight’s Senior Living that he’s heard frustration from providers over the lack of power, especially because the storm was expected. But he said that long-term care providers will debrief in the wake of Beryl and consider lessons learned and do better next time. 

Texas Assisted Living Association President and CEO Diana Martinez told McKnight’s Senior Living that Gulf Coast residents proved to be “some of the toughest Texans in the state,” showing resilience in the face of unrelenting summer heat and days of frustration. Despite widespread power outages, assisted living communities continued to meet the health and safety needs of their residents, she said.

“They have provided residents with hot meals, safe spaces to cool down and offers to temporarily relocate,” Martinez said, adding that one of the biggest challenges has been a lack of information from the utility company to the area’s senior living communities. “Staff, residents and families all make better decisions when they have useful information, and useful information has been hard to come by.”

Once power is fully restored and the initial rush to recovery is passed, she said, TALA will meet with state and local leaders to find ways to improve emergency communication moving forward, to ensure “priority restoration means priority restoration.”

Argentum similarly called on state officials to prioritize power restoration for senior living communities.

“We are particularly concerned about the well-being of seniors in affected areas who are facing a potentially life-threatening situation due to power outages and disruptions in care,” Argentum Senior Vice President of Public Affairs Maggie Elehwany said. “Senior living communities rely heavily on electricity to maintain a safe and healthy environment, and restoring power must be a top priority for state and local officials.”

Argentum further called for an additional federal response to support Texas in resolving the crisis.

Generator discussions resurface

Texas requires long-term care facilities to have alternative power sources to refrigerate medications and maintain life saving equipment. But no requirement exists for generators to power heating and cooling systems, according to the Texas Tribune. Many properties have generators, but they are not large or powerful enough to cool entire buildings. Most often, generators and fans are set up in a common area for residents. 

Clardy said there is a cost-benefit analysis that providers must consider about spending limited resources on a large generator that might be used sparingly. Provider members feel morally and ethically compelled to provide care and make tough decisions, he said, but ultimately, long-term care residents are better off than their counterparts living alone in the greater community at large due to the professional staff members in senior living communities who are on hand to care for them.

No deaths or serious injuries were reported following the storm. Texas Director of Emergency Management Nim Kidd told the Baytown Sun that it would hold operators accountable if they did not keep residents safe. 

“That location is responsible for the health, safety and welfare of the patients and residents that are there; it is that facility’s responsibility,” Kidd told the media outlet.

State legislation attempting to require backup generators at assisted living communities and nursing homes have stalled in committee. The large price tag associated with the devices, as well as the feasibility of such a requirement, have sunk previous bills, although some lawmakers have vowed to resurrect them during the next legislative session, according to the Texas Tribune. 

Other states have passed legislation regarding emergency power sources, including Florida, which adopted a law following Hurricane Irma in 2017. Virginia passed a similar law in 2019 requiring assisted living communities to maintain adequately sized emergency generators or to accept mobile generators. Oregon requires assisted living communities offering ventilator-assisted care to have functional emergency backup generators. And Maryland requires assisted living communities to have emergency electrical power generators on site. 

In a 2022 survey by the Texas Health and Human Services Commission, 47% of assisted living provider respondents reported having a generator on hand, and 99% of nursing facilities said they had one. 

On Friday, US Department of Health and Human Services Secretary Xavier Becerra declared a public health emergency for Texas to address the health effects of recent severe weather. The action followed President Biden’s emergency declaration and gave the Centers for Medicare & Medicaid Services, healthcare providers and suppliers greater flexibility in meeting emergency health needs of Medicare and Medicaid beneficiaries.

Best practices

Extended power outages can have significant financial implications for senior living communities, according to David Thurber, CAC Specialty senior vice president of legal, including increased operational costs due to the need for additional resources like fuel for generators, food and medical supplies. There may also be costs associated with repairing damage caused by the disaster, and upgrading infrastructure to prevent future outages.

“Additionally, there can be a financial strain from potential liability issues if residents suffer harm due to inadequate emergency responses,” he said. “Having comprehensive insurance coverage is crucial to mitigate these financial risks and ensure the community can recovery quickly.”

Senior living communities will want to understand in advance how resident rents will be paid/collected, and what offsets, if any, due to temporary accommodations after the storm, Thurber said. Lost business income, he said, is important to understand in advance and to collect all critical ongoing financial information during any emergency event.

Risk management also plays a crucial role in preparing/planning/training for and handling power outages during emergencies.

“This involves identifying potential risks, developing comprehensive emergency plans, and conducting regular risk assessments and drills, and to update these plans as needed,” Thurber said. “Effective risk management also includes investing in infrastructure improvements and training programs to mitigate risks.”

Preparing for emergencies begins with regular staff training and education, according to Alex Whipple, senior vice president of CAC Specialty, a specialty insurance broker. The regularity of drills –which should take all stakeholders into account — helps staff and residents remain calm and efficient during actual emergencies.

Whipple also stressed communication, which should include families and setting expectations early to lower anxiety.

“Establish clear communication standards in the event of an emergency and stick to them,” he said. “This includes creating a clear chain of command and designating roles and responsibilities for staff on site.”

For extended power outages, especially in states like Texas where backup generators might not cover air conditioning, Thurber said it’s essential to have a robust plan.

Among the best practices he outlined were ensuring adequate backup power to support critical systems beyond basic lighting, such as medical equipment and designated cooling areas. Maintain an inventory of essential supplies and regular maintenance of backup power systems is imperative as well. Thurber also recommended seasonal preventive measures, such as trimming trees and bushes, cleaning gutters, and inspecting and maintaining equipment.